| Objective:To analyze the incidence,clinical features,diagnosis,treatment and prognostic factors of single-center multiple myeloma(MM)in our hospital.Methods:Case data of 173 patients with NDMM from January 1,2013 to December 31,2022 at the First Hospital of Lanzhou University were collected and retrospectively analyzed regarding their general information,clinical features,ancillary examinations,diagnosis and treatment,and prognosis of efficacy.All patients met the International Myeloma Working Group(IMWG)MM diagnostic criteria and were staged using the International Staging System(ISS),and the efficacy was evaluated with reference to the Chinese guidelines for the diagnosis and treatment of multiple myeloma(revised 2022).Results:1.The median age of onset was 62 years old,with a bimodal age curve and peak ages of 52 and 60 years old.102 patients(59.0%)were<65 years old,with statistically significant differences(P<0.05)in the number of annual visits among different age groups.2.Among the 173 patients,81(46.8%)were farmers by occupation;the most common first department was hematology in 98 cases(56.6%),followed by orthopedics in 13 cases(7.5%),geriatrics in 11 cases(6.4%),emergency medicine in10 cases(5.8%),nephrology in 8 cases(4.6%),rheumatology in 7 cases(4.0%),and others in 26 cases(15.0%).3.The most common initial symptom in 173 patients was bone pain in 102cases(59.0%),and M protein type was more common in 89 cases(51.4%)of Ig G type,43 cases(24.9%)of Ig A type,and 23 cases(13.3%)of light chain type;among 151patients with ISS staging at the time of initial diagnosis,78 cases(51.7%)of stage III,44 cases(29.1%)of stage II,and 30 cases(19.2%)of stage I(19.2%).4.Of the 168 patients tested,70.2%had anemia(Hb<100 g/L)and 29.8%had thrombocytopenia(Plt<100×10~9/L).18.6%of the 167 patients tested had combined renal insufficiency(Cr≥177 umol/L);of the 165 patients for whom corrected serum calcium(c Ca)was available,13.9%had combined hypercalcemia(c Ca≥2.75mmol/L).5.Immunoinflammatory indexes,including neutrophil/lymphocyte ratio(NLR),platelet/lymphocyte ratio(PLR),and lymphocyte/monocyte ratio(LMR),were available in 148 cases by calculation.The differences in PLR levels between patients with different ISS stages were statistically significant(P<0.05).85 cases were tested for the ratio of peripheral blood T lymphocyte subsets at the initial diagnosis,including CD3~+T cells,CD3~+CD4~+T cells,CD4~+CD8~+T cells,percentage of Treg cells and CD4/CD8 ratio.There was no statistically significant difference between the proportions of peripheral blood T lymphocyte subsets in patients with different ISS stages(all P>0.05).6.163 cases were tested for lipid-related indexes,including total cholesterol(TC),triglycerides(TG),high-density lipoprotein(HDL-C),and low-density lipoprotein(LDL-C).The differences between TC,HDL-C,and LDL-C levels in patients with different ISS stages were statistically significant(all P<0.05).7.170 cases had perfected bone imaging at the initial diagnosis,of which65.9%had bone destruction,and CT+X-ray was the most common means of examination,244 cases(61.3%);of the 91 cases for whom complete information on bone marrow FISH test results were available,66 cases(72.5%)were positive,including 30 cases with combined RB1 deletion,28 cases with IGH rearrangement,27cases with D13S319 deletion,27 cases with Among them,30 cases had RB1 deletion,28 cases had IGH rearrangement,27 cases had D13S319 deletion,22 cases had 1q21amplification,and 22 cases had P53 deletion.8.Of the 173 NDMM patients,17 cases(9.8%)underwent ASCT and 148 cases(85.5%)received induction chemotherapy.Patients were divided into four groups according to treatment regimen.39 cases(26.4%)in the PIs-containing regimen,36cases(24.3%)in the IMi Ds-containing regimen,60 cases(40.5%)in the combined PIs+IMi Ds regimen,and 14 cases(9.3%)in the no PIs or IMi Ds regimen group.9.Among the 113 patients with evaluable efficacy,26.6%had complete remission(CR),23.9%had very good partial remission(VGPR),21.2%had partial remission(PR),15.9%had stable disease(SD),12.4%had disease progression(PD),and 71.7%had an overall effective rate(ORR).Statistically significant differences were observed between the efficacy of patients grouped by age,ISS stage,and induction chemotherapy regimen(all P<0.05).10.Among the 145 patients who could be followed up to survival outcome,the overall m OS was 23(2 to 114)months,with significantly higher m OS in the age<65years group than in the≥65 years group(53 months vs 38 months),significantly lower m OS in patients with ISS stage III than in stage I/II patients(29 months vs 47months),and significantly higher m OS in patients using the combination regimen of PIs+IMi Ds than Patients on the combined PIs+IMi Ds regimen had a significantly higher m OS than patients on the PIS or IMi Ds regimen(65 months vs.35 months),with statistically significant differences between the above groups(all P<0.05).11.Single-factor analysis of prognostic survival showed that age≥65 years,ISS stage III,combined FISH detection of genetic abnormalities,PLt<100×10~9/L,c Ca≥2.75 mmol/L,andβ2-MG≥5.5 mg/L were risk factors affecting prognostic survival of NDMM patients,and the use of PIs+IMi Ds combined induction chemotherapy regimen was a protective factors for survival(all P<0.05);multifactorial analysis showed that age≥65 years,ISS stage III,Plt<100×109/L,andβ2-MG≥5.5 mg/L were independent risk factors affecting the prognosis of NDMM patients(all P<0.05).Conclusions:1.The median age of onset is 62 years,and patients with NDMM are more likely to be of non-senior age(<65 years).2.The most common initial symptom is bone pain,and the ISS stage at the time of initial diagnosis is mainly stage II+III,and the immunotyping is mostly Ig G,Ig A and light chain type.3.The most common type of genetic abnormality detected by bone marrow FISH was RB1 deletion.4.The proportion of those who received ASCT was low,and induction chemotherapy was dominated by new drugs containing PIs and IMi Ds,among which the most people chose the combination regimen of the above two drugs;age,ISS stage and initial induction chemotherapy regimen were the relevant factors affecting the final outcome of patients.5.Age≥65 years,ISS stage III,Plt<100×10~9/L,andβ2-MG≥5.5 mg/L were independent risk factors affecting the prognosis of NDMM patients. |
PDF Full Text Request